Spot sign score predicts rapid bleeding in spontaneous intracerebral hemorrhage

Abstract

This study was conducted to determine whether spot sign score correlates with average rate of hematoma expansion and whether average rate of expansion predicts in-hospital mortality and clinical outcome in spontaneous intracerebral hemorrhage (ICH). The study included 367 patients presenting to the Emergency Department (ED) from January 1, 2000 to December 31, 2008 with nontraumatic ICH. All received noncontrast computed tomography (NCCT) of the head and multidetector CT angiography (MDCTA) on presentation to the ED and a follow-up NCCT within 48 h. Imaging was used to determine the hematoma location and volume, average rate of expansion, and spot sign score. Primary outcome measures included in-hospital mortality and clinical outcome based on modified Rankin Scale at 3 months or at discharge. Regression analysis was performed to correlate spot sign score and average rate of hematoma expansion. ICH expansion was identified in 194 of 367 patients (53%). In a multivariate analysis, rate of ICH expansion predicted mortality (hazard ratio 1.1, CI 1.08-1.12, p < 0.0001). Patients who expired had an average rate of ICH expansion of 2.8 ml/h compared to 0.2 ml/h in survivors. Spot sign score on presentation to the ED correlated with the average rate of hematoma expansion. Average rate of hematoma expansion predicts mortality in spontaneous ICH. Spot sign score on presentation correlates with rate of expansion, supporting the hypothesis that high spot sign scores likely reflect active bleeding in acute ICH.

Fig. 1

Comparison of the average rate of ICH expansion (ml/h) of patients who expired and patients who survived

Fig. 2

Correlation of average rate of ICH expansion and probability of survival

Fig. 3

Comparisons of the average rate of ICH expansion of patients with baseline ICH volume < 30 ml to patients <30 ml and mortality. p Values: 0.002 (Initial ICH<30 ml, Survivor to Expired); 0.02 (Initial ICH>30 ml Survivor to Expired)

Fig. 4

Comparisons of the average rates of ICH expansion within the different time frames of follow-up imaging and mortality

Fig. 5

Average rate of ICH expansion compared to assigned spot sign score in patients who survived and patients who expired